Blood is Thicker than Water
by Arress
Summary: Johnny discovers he has a little known medical condition.


Blood is Thicker Than Water

By Arress

Disclaimer: All things Emergency! belong to Mark VII Productions and Universal Studios. None of the characters belong to me, I'm just using them for a while. I am not making a profit with this story.

AN: Many thanks to my beta readers; Audrey, Chet's Pet, Sue, and Tammy. Your help is really appreciated.

AN #2: I posted this story, along with several others, years ago on Audrey's Emergency Fan Fiction site under the pen name bekysu. As I've started writing fanfiction again, I decided to post it here too.

There is a glossary at the end, if there are terms you don't understand.

XXXXXXXXXX

Johnny Gage and Roy DeSoto stood before their lockers changing into their street clothes at the end of a very long, very difficult shift, but Johnny was whistling a happy tune as he changed.

"Are you all ready for your trip?" Roy asked.

Johnny informed Roy with a smile, "Yep, my bags are already in the Rover, and I'm headed for the airport as soon as I leave here." He couldn't be happier. Starting today, he had two weeks off in the paradise known as Hawaii. He was really looking forward to this trip. He had never been there before, and couldn't wait to meet some beautiful Hawaiian girls. Actually, he was making the trip alone for that very reason.

"Still planning on going alone?"

"Of course I am. How am I gonna meet any women if I take anybody along?"

"Well, I thought since it's summertime and the kids are out of school, you could take them with you. Joanne and I could really use a break," the senior paramedic teased his partner with a mischievous glint in his eyes.

Gage replied nervously, "Don't get me wrong, Roy. I love your kids, but they are not coming with me to Hawaii."

Roy broke out laughing, and said, "I was just teasing you, Johnny."

"Well, don't scare a guy like that."

"When does your flight leave?"

"In about two hours. The way traffic's gonna be, I better hit the road."

"You have a good time, and give me a call when you get there."

"Will do, but don't expect a call every night. Hopefully, I'll be too occupied."

Chet Kelly walked in the locker to get changed himself, and heard Johnny's last comment, "Too occupied with what, doing crossword puzzles?"

"Shut up, Chet. I'm going to be in Hawaii. I think I can find something better to occupy my time than doing crossword puzzles," Gage said. "Now if you'll both excuse me, I don't want to miss my flight."

"Have a good time," Roy said.

"I plan to," Johnny replied, as he closed his locker door. "Somewhere in Hawaii is a beautiful woman just waiting to meet me." He said dreamily.

Kelly said, "Dream on, Gage. They'll probably all run the other way when they see you coming."

"Chet, you're just jealous. I'm gonna be in Hawaii meeting beautiful women, and you're gonna be stuck here putting out dumpster fires," Johnny retorted as he left the room.

Kelly turned to Roy and said, "I hate to admit it, but he's right. I am kind of jealous."

XXXXXXXXXX

The lanky paramedic headed out to his Land Rover. He had arranged a flight out from LAX two hours after the shift ended. He wanted to get to his planned destination as soon as possible.

He made his flight on time, and after a six-hour flight, landed in Honolulu, Hawaii. Once the plane taxied to a stop at the terminal, he gathered his carry-on luggage and made his way off the plane to go search for his large suitcase in the baggage claim area. As Gage walked across the large airport, he noticed his left leg was aching, but attributed it to stiffness after the long flight.

The paramedic claimed his suitcase, found the exit, and made his way outside. He hailed the first taxi he came across. The taxi driver assisted him with putting his luggage in the trunk. Johnny directed the driver to the hotel where he already had a reservation. Gage had made certain that he got a room in a beachfront hotel. Now he wanted to get settled as soon as possible so he could hit the beach for a little while before having a late dinner.

Once in his room, Johnny called Roy to let him know that he had arrived okay. Afterwards, he did a little unpacking; just enough to locate his swimming trunks, and quickly changed into them. That's when he noticed his lower left leg was swollen and red. "Well, that explains why my leg is aching," he said to himself as he sat on his bed. Being a paramedic, he could make a pretty good diagnosis as to what was causing his leg to swell. He knew it was somewhat common for a person to develop a blood clot in the deep veins of the leg after sitting for a long period of time, such as on a long airplane flight, and he had all the right symptoms. "I don't believe this," he groused out loud, knowing he needed medical attention, "What a vacation this is already turning out to be. I haven't even make it to the beach yet."

Gage took a quick shower, got dressed, and made his way outside to find another taxi to take him to the nearest emergency room.

Once in the taxi, the dark-haired man marveled at all the beautiful scenery he probably wasn't going to get to enjoy on his long-awaited vacation in paradise.

The taxi pulled up to the emergency room entrance. Gage paid the driver and went inside. He really wasn't looking forward to this.

After a short wait, the paramedic was taken to an examination room by a nurse, and directed to change into a hospital gown. After accomplishing that, he climbed onto the examination bed and gingerly lifted his sore left leg onto the bed to elevate it.

A man in a traditional white doctor's jacket entered the room accompanied by a nurse. "Hi, Mr. Gage." He introduced himself, "I'm Dr. Kimo. What seems to be the trouble?"

"First of all, call me Johnny." The paramedic paused a few seconds before voicing his concern. There was only one way to say it; "I think I have a blood clot in my leg."

As the doctor examined Johnny's leg he said, "Well, it certainly could be that, or it may be something else. We'll do a venous ultrasound and see what we have. Are you here on vacation?"

"Yeah, I just arrived a couple of hours ago."

"How long was your flight?" Dr. Kimo asked.

"About six hours."

The doctor then questioned, "How long has your leg been like this?"

"I first noticed it when I got to my hotel room an hour or so ago. My leg did hurt some when I first got off the plane, but I thought it was just stiff from the long flight."

"Did you get up and walk around any while you were on the plane?" Dr. Kimo inquired.

"Just once to use the facilities. I didn't want to get in the way of the stewardesses," Gage replied. "I mostly just sat and talked to the passenger sitting next to me."

As he continued his examination, Dr. Kimo stated, "I wish people would get up and walk around more when they're on long flights. That's generally enough to prevent any problems with DVT's. Tell me, what made you think of a blood clot? Most people don't know about things like that."

"I'm a firefighter/paramedic from LA County. You'd think I would know better than to sit that long. I've seen this kind of thing on the job myself."

"Well, before we go jumping to any conclusions, let's get the ultrasound. It could just be phlebitis."

"If I'm lucky," Johnny said dejectedly, not really believing it was quite that simple.

XXXXXXXXXX

As Johnny lay on the examination bed in the ultrasound room at the hospital, he watched the technician. He watched her closely as she did the exam, placing the transducer on specific areas on his leg and watching the monitor that the images were projected on. She also leaned over to squeeze his leg in certain places while she kept her eyes on the screen. He knew from experience that you could usually tell the results of a test by watching the technicians as they worked. Though they couldn't disclose to the patients what they found, the look in their eyes often gave away the results, especially when they were bad.

He was seeing that look now.

The tech finished the exam and took Johnny back to his room in the emergency department, and told him the doctor would be back to see him soon.

XXXXXXXXXX

When the doctor entered the room again a few minutes later, Johnny didn't wait for him to speak, and blurted out, "I have a DVT, don't I Doc."

"That's what the ultrasound shows," Dr. Kimo replied. "I'm terribly sorry."

"I just knew it. So much for my vacation," Johnny complained rather bitterly. He then added, "I'm only 32. I'm too young for this crap!"

"Johnny, you know anyone can get a DVT after sitting for a long period of time," Dr. Kimo said. "We'll get you admitted and started on heparin right away. At least we caught it early before it could break off and travel to your lungs."

"Thanks, Dr. Kimo. I'm sorry for spouting off like that. It's not your fault. It's just that I've saved for this vacation for a long time, and now it's ruined."

XXXXXXXXXX

'Chet was right,' Johnny thought to himself as he lay in his hospital bed a couple of days later, 'I'm spending my vacation doing crossword puzzles.' The three days of bed rest the doctor had ordered was really getting on his nerves.

The only highlights of his days were the arrival of the meals, such that they were, and the puzzle book a kind nurse had given him to keep him occupied.

He was on heparin, an intravenous blood thinning medication, and he had to keep his leg elevated as much as possible and use a heating pad to help with the pain.

Gage hadn't called any of his friends back in LA. He didn't want them to worry about him, to know his vacation had been ruined. He just knew that one of them; probably his paramedic partner and best friend, Roy, would jump on the first plane to Honolulu to be with him. He didn't want to take Roy away from his family or his job. He also knew that Roy couldn't really afford a plane ticket or to miss work.

But he was very lonely, and very bored. The only visitors he received were medical personnel.

XXXXXXXXXX

After being on the intravenous heparin for a few days, Gage's medicine was switched to Coumadin, an oral blood thinning medication. Once his protime was at the optimal level, he was discharged after a total of six days in the hospital, with instructions to keep his leg elevated as much as possible. He was also directed to wear TED hose for his flight home. Dr. Kimo advised to get up and move around as much as possible to keep the blood flowing in his legs on the long flight.

The doctor also advised the dark-haired man not to return to duty as a firefighter/paramedic as long as he was on the Coumadin, which would be a total of three months. The doctor stated that the paramedic's job was too dangerous to do while on a blood thinner, and he should be on light duty. He advised Gage to see his family doctor as soon as he arrived home, supplying the paramedic with a copy of his medical records to give to his doctor in LA. He also advised Johnny to get his protime checked at least once a week to make sure it didn't get too high, and was told to avoid foods high in vitamin K, such as green leafy vegetables, since they could make his protime too low and harder to control.

Since Gage hadn't told anyone in LA of his hospitalization, he figured he would keep on working at his regular job, get his protime checked someplace other than Rampart, and just keep this little incident to himself. To his credit, he did follow all of the doctor's other instructions.

Actually, the last half of his vacation wasn't half bad. Johnny just kept mainly to the beach and shops around his hotel, and when his leg started to ache, he rested and elevated it wherever he happened to be at the time.

Gage was worried about the flight back, but followed Dr. Kimo's advice by wearing the TED hose, and he got up and moved around frequently while in the air. The paramedic made it back to LA without any problems.

XXXXXXXXXX

Back on duty once again, the lanky paramedic ran through the station, in a hurry to get changed so he could make roll call on time. He was running late again, as usual.

His partner, Roy, was standing at his locker buttoning his shirt when Johnny slid to a stop beside him at his own locker. He hurriedly began changing into his uniform.

"Hey, Johnny. How was your vacation?" DeSoto asked. "I thought I'd hear from you before you got back to work."

"It was great. I just got in last night, and didn't want to call you that late." Johnny replied with a notable lack of his usual exuberance, as he continued to get dressed.

Roy eyed his partner suspiciously, thinking 'something is not right here, he's not nearly as excited as he should be, having just returned from his dream vacation.' He said, "All right, who are you and what have you done with my partner?"

"What do you mean by that, Roy?" the younger paramedic asked, as he turned to look as his partner.

"I just thought you'd be more excited. I mean, you just spent two weeks in Hawaii."

"I was excited while I was there, but now I'm back," Johnny stated.

"So that's it, back to the old grindstone, huh?" Roy smiled. "Do you have any good vacation stories to share?"

Gage put the finishing touches on his uniform, and stated, "Don't have time now. We have to get to roll call. I don't want to be late my first day back." He left the room, leaving Roy staring dubiously at the closing door, pondering his best friend's lack of enthusiasm and thinking, 'he must not have met any women on the trip'.

He followed Johnny out of the locker room to join him and the rest of the guys for roll call.

XXXXXXXXXX

Johnny's first two weeks back at work went rather smoothly. He had no problems, and continued on his blood thinner and got his protime checked every week as Dr. Kimo had advised. He found a clinic in his neighborhood where he could get the blood test, and nobody at the station or at Rampart had a clue. He just had a couple of months to get through and no one would be the wiser.

Gage should have known his luck wouldn't hold out. He and Roy were on a routine rescue, removing a child from the trunk of a car. The eight-year-old boy had been playing hide and seek with his sister, and thought the trunk was the perfect hiding spot. The child didn't think about how he was going to get out of the trunk. He had seen his parents use the keys to access the trunk, which is what he did. But he still had the keys in his hand when he shut the lid. The child's mother couldn't locate the spare set of keys, and called the Fire Department.

The lanky paramedic used a crowbar to pop the trunk. When it sprang open, the crowbar slipped and cut his left arm. The wound began to bleed profusely. Gage applied a pressure bandage to the cut while DeSoto checked the boy, and reassured the mother that the child was fine, but she could check with her pediatrician if she wished.

The senior paramedic turned to Johnny, who was putting the finishing touches on the bandage, and said, "Let's get you to Rampart. I think you're gonna need stitches for that."

"Oh, it's just a scratch, Roy, I'm fine."

"That cut is bleeding too much, you need stitches. Let's just go to the hospital and get this over with," Roy said forcefully.

Gage knew he didn't stand a chance when his partner used that tone, and as he noted the blood already seeping through the bandage he had just applied, he agreed, "Oh, all right. Let's go." When he got to the squad, he put on his dark blue uniform jacket to cover his injured arm, got in the truck, and shut the door. He thought to himself, 'I think the jig may be up'.

Johnny applied pressure to the cut the entire trip to the hospital, but the bleeding wouldn't stop. His jacket sleeve was soaked with blood by the time they arrived at their destination, and he was feeling very lightheaded. He dazedly watched the blood run down his hand and drip on the floor of the squad. He also noted some buzzing in his ears. He knew he should tell his partner about these things, but he couldn't seem to find his voice.

Roy pulled the squad into the lot at Rampart and parked near the emergency room doors. He got out of the squad and went over to his partner's side and opened the door. The younger paramedic stepped out of the vehicle. With the sudden change in position, he became severely lightheaded and dizzy. He immediately collapsed.

Acting quickly, DeSoto caught his partner and eased him to the ground. He ran the short distance to the emergency room, stuck his head through the door, searching for help. He saw Dr. Brackett and Dixie standing at the desk down the hall and shouted, "I need some help out here! Bring a gurney." He then went back to his best friend's side, and started checking him over.

Dr. Brackett and Dixie wasted no time grabbing a gurney and rushing to help Roy. They found him kneeling next to an unconscious Johnny, who was lying on the ground next to the squad.

Dr. Brackett asked, "What happened, Roy? We didn't hear anything at the base station."

"He cut his left arm while we were helping a little boy who was trapped in the trunk of a car. I didn't think it was that bad. He didn't say anything to me. He just passed out when he got out of the squad." Roy explained hurriedly.

Dr. Brackett and Roy lifted Johnny onto the gurney and rushed him inside. Dixie held the door open for them, and then led them to Treatment Room Two.

Dixie cut the left sleeve of Johnny's jacket, and they immediately spied the blood-saturated bandage, "His sleeve is completely soaked with blood, Kel."

The senior paramedic moved out of the way and watched the proceedings, but didn't leave the room. He was not willing to do so unless directly asked to go.

"He seems to have lost quite a bit," Dr. Brackett observed. He then ordered, "Dix, start an IV of NS, check an H&H, and then get two units of Johnny's blood type ready to hang. You do remember his type, don't you?"

"How could I forget?" She asked dryly, "He's had enough transfusions to start his own blood bank."

"We've got to figure out why he's bleeding so much," Dr. Brackett said as he applied pressure to the wound. "It doesn't look like he cut an artery. Dixie, I want you to draw a protime too, and tell the lab I want the results stat."

XXXXXXXXXX

After the fluids and a unit of blood, Johnny slowly woke up and saw the faces of his three worried friends. He looked around the treatment room in confusion, and asked, "What happened?"

"You passed out because you lost too much blood," Dr. Brackett informed his patient, "but we gave you a transfusion and you're going to be fine."

DeSoto came up to the bed and said to his friend, "You really scared me there, collapsing like that when we got here."

"Sorry, Roy. I didn't think the cut was that bad."

"It wasn't that bad," the doctor stated, "we only had put ten stitches in it. You didn't cut an artery, but it wouldn't quit bleeding until we put in the stitches. We checked your bleeding time, and found it to be abnormally elevated. I'm going to have to run more tests to try and figure out why your protime is so high."

'The jig is definitely up,' Johnny thought. He sighed, and spoke, "There's no need for that, Doc. I know why it's elevated." As he explained what had happened while he was in Hawaii, all three faces hovering around him registered shock and dismay.

Dr. Brackett admonished Johnny, "You know you should be on light duty. Your job is too dangerous to do while you're on a blood thinner."

"That's what Dr. Kimo said," Gage replied, chastised. "I just thought I could make it through a couple of months without any problems."

DeSoto put in, "Johnny, you know what just happened. A minor injury turned into a major crisis. You could have bled to death. You're really lucky that we were already at the hospital when you passed out."

"I'm sorry, Roy. I didn't mean to cause any problems. I just didn't want to have to stop working. I love my job."

"Johnny, we know you do," Dixie interjected, "but your health is more important, and besides, it's only temporary."

Dr. Brackett stated with concern, "I'm putting you on light duty until the blood thinner is discontinued. I'm sure the Fire Department can find something for you to do in the meantime."

"Can't I just stop the blood thinner early? I mean, what are the chances that I'll have another problem anyway? The DVT was caused by the long plane ride." Johnny tried to reason with the stubborn physician.

Dr. Brackett crossed his arms as he glared at the paramedic lying down in front of him, "I can't let you do that, Johnny. The standard treatment for DVT is three months of Coumadin to prevent a recurrence."

"But . . ." the dark-haired paramedic tried again.

"End of discussion, Johnny," Dr. Brackett said sternly. "You know what a DVT can lead to, and it's nothing to fool around with. We're talking about your life here. Whether you like it or not, my decision is final."

Roy tried to reassure his friend, "Don't worry about it." As he patted Johnny on the shoulder he said, "Like Dixie said, it's only temporary. You'll be back to work in a couple of months."

"It sure is going to be a long two months. I get so bored sitting around my place." Johnny complained.

"I'm sure the department will have something to keep you busy," DeSoto assured his partner. "You could work in dispatch, and it'll be over before you know it."

Gage changed the subject, "When can I get out of here, Doc? I need to go to headquarters and get another assignment."

"As soon as your IV and blood are done infusing, you can go. However, I do want you to take a couple of days off before you take another job in order to get your strength back. I want you back here in a few days to check your protime and your hemoglobin. I need to make sure you're not anemic after today's little episode."

"Johnny, I'm gonna go call the station and let Cap know what's going on," DeSoto said, "He's probably wondering what happened to us."

"Man, now everybody's gonna know," the young paramedic complained. "This is one of the things that I was trying to avoid."

"They'll understand, Johnny." Roy said, and then added, "I just wish you would have let me know you were in the hospital while you were on vacation. You shouldn't have had to go through that alone. You know I would have been there for you if I had known. You're like family to me."

"I know, Roy, you're like family to me too. You and the guys are the only family I have. I just didn't want to worry anybody," Johnny said.

"Johnny, I want copies of your hospital records from Hawaii," Brackett commented. "What was that doctor's name again?"

"I have the records at home. He gave them to me to pass on to my doctor. I'll bring them in tomorrow," Johnny said in defeat.

XXXXXXXXXX

For the next two months, Johnny worked in dispatch and took his Coumadin. He didn't like working in dispatch very much, but it was better than sitting around at home. He missed working with Roy and the rest of the guys. He missed his 'family'.

He saw Dr. Brackett when the two months were up, and was instructed that he could go off the Coumadin, but was admonished to come in with any symptoms of a DVT or a pulmonary embolism. Gage assured the doctor that he would. Brackett gave the paramedic his release papers. He drove immediately to Station 51 to inform his captain that he could return to work.

XXXXXXXXXX

Johnny was back at work for approximately two weeks when his leg, this time the right one, began to ache. He hoped he had just pulled a muscle or something, and it was not what he feared it was. He knew the implications if he got another DVT. He would probably have to go back on Coumadin indefinitely, and would no longer be able to continue his career as a firefighter. He conveniently forgot about the promise he made to Dr. Brackett.

XXXXXXXXXX

After returning from a particularly grueling fire, Gage made sure he was first for the shower. He stripped and stepped into the shower stall, and finally got a good look at his right leg that had been aching all day. "Oh man," he said to himself, "not again." His right leg looked much like his left one had in Hawaii. It was red, swollen, and warm to the touch. He decided not to tell anyone, hoping it would get better on its own. He really didn't want to give up his career. He figured that once he got off shift he could elevate it and use the heating pad, and the clot would dissolve on its own with time. He could even take some of his leftover Coumadin to help things along.

The shift was only half over, so when he finished his shower, he got dressed in a clean uniform and tried not to limp as he made his way into the dayroom to join the rest of the guys.

Roy, astute as always, noticed his partner trying not to limp and asked, "What's wrong with your leg?"

The younger paramedic looked like a deer caught in headlights for a moment, and then replied, "I must have pulled a muscle or something when we were hauling hose."

"What me to take a look at it?"

"I just looked at it when I was in the shower. It's fine."

DeSoto then said, "Well, let me know if you change your mind. Now, I think I'll grab a shower before we get toned out again."

XXXXXXXXXX

For the next few hours, all was quiet in the station. The guys actually got to eat a meal uninterrupted, and were involved in a friendly game of poker when the tones sounded. The dispatcher's voice came over the intercom, stating, "Station 51, people trapped in an elevator. 5522 Alameda, 5 – 5 – 2 – 2 Alameda, cross street 18th, time out 21:21."

The men were on their feet and in their vehicles before the dispatcher's voice finished. Cap acknowledged the call, handed the senior paramedic the call slip through the window of the squad, who then passed it to his partner. The captain then hurriedly took his own place in the engine.

When they arrived at the correct address, which was a ten-story apartment building, a man in his 50's came out to meet them. The captain went up to him and said, "I'm Captain Stanley from the LA County Fire Department. What seems to be the trouble?"

"I'm the manager of this place, name's James Miller. The elevator is stuck between the sixth and seventh floor with an old couple inside. We would've just waited for the repairmen to come, but I think the man is having some trouble. He does have a heart condition."

"We'll take care of it, Mr. Miller," Captain Stanley assured the man. He then turned to Roy and Johnny, who were standing behind him waiting for instructions, "You two see if you can go get the doors to the elevator open and find out what's going on. Call us on the HT and let us know what equipment you'll need to get those people out."

"Right, Cap," both paramedics replied simultaneously. Gage grabbed a pry bar and the biophone, DeSoto grabbed the drug box and the oxygen, and they headed into the building.

Once at the elevator doors on the seventh level, Gage quickly pried the doors open with the pry bar. He looked through the doors and could see that the elevator was about halfway between the floor they were on and the one below it.

He looked at his partner, "We're gonna need safety belts and lines so we can haul them out of there, and we'll need the guys to anchor them. I don' t see anything in this hallway to use. Have them bring up the stokes too."

Roy pulled the HT out of his pocket, "Okay, I'll call Cap and let him know."

As DeSoto made the request, the younger man called down to the occupants in the elevator, "This is the Fire Department. Can anybody hear me?"

An old woman's voice could be heard replying, "Oh, thank God you're here. My husband is having chest pain. We need to get him out of here."

"Okay, ma'am. I'll be right down to help, and we'll have you and your husband out of there as soon as possible," Gage called to her. He turned to Roy, who had just finished the call to the captain, "I need to get down there. That guy may be having a heart attack. I'll use the elevator cables to lower myself down and then you can hand me the drug box and the oxygen. It's only ten feet or so. I think I can make it."

The senior paramedic was worried about the man in the elevator too, and said, "Okay, go ahead. When the guys get here I'll join you, and they can pull us up when we have him stabilized."

Johnny reached through the open elevator doors and grabbed the elevator cables. He shimmied his way down to the roof of the elevator. When he had just a couple of feet to go, his gloved hand landed on a particularly slick area on the cable. His hand slipped and he ended up dropping the rest of the way. Gage landed hard on his feet, and a sudden sharp pain shot up his right leg. The pain left him gasping, and he ended up on his rear, trying not to cry out in pain.

DeSoto had been watching his friend's descent, and after witnessing the fall, he called down to his partner, "Are you okay?"

"I'm okay. My hand just slipped on a slick spot," the dark-haired man answered as he got back on his feet. "Throw me the drug box and the oxygen."

DeSoto tossed the drug box, waited while the younger man caught it and set it down, and then dropped oxygen tank down to him. After setting the tank down, Gage then looked for the trap door that was supposed to be present on all elevators roofs. He located it, pulled it open, and immediately spotted the couple inside. An elderly woman was kneeling next to her equally elderly husband, holding his hand. Johnny asked her to stand up and take the drug box and oxygen for him. Once she stood up and came over to the trap door, he handed the items down to her, and then dropped into the elevator. As he landed, Gage tried to take most of his weight on his left leg, as his right leg wasn't feeling too great. He managed not to fall over by grabbing the side of the elevator, and then set to work on the man.

By the time he got the patient's vitals and started the oxygen, Roy arrived on the elevator roof with the biophone. He handed it down to the elderly woman, and dropped into the elevator also. He set up the biophone, and called to Rampart. Johnny handed him a slip of paper with the patient's vital signs, and Roy relayed the necessary information.

The paramedics followed the instructions they received from the base station. DeSoto stood up and called through the open door at the top of the elevator, "Chet, Marco, send down the stokes."

His shift mates complied, and the paramedics soon had the man strapped in the stokes and ready to transport. The men on top pulled the patient up and out of the trap door as Roy guided it through. Once the man was out, Roy went next, and once he was out, the elderly woman was also pulled out with the use of a safety belt and rope. Johnny handed the equipment up to Roy, and then was pulled out of the elevator.

DeSoto was pulled up to the seventh floor and joined the patient and wife, and his fellow crewmembers. As Johnny was waiting for his turn to be pulled up, the elevator suddenly dropped a few feet. Gage desperately grabbed for the elevator cables so he wouldn't follow the elevator down. However, his hand slipped, and he dropped the few feet to the elevator roof before anyone was able to grab hold of his safety line. His sudden drop had surprised Kelly and Lopez, and it took them a couple seconds to grab his line.

The younger paramedic landed on his feet on the roof of the elevator, and excruciating pain shot through his right leg again. The pain was so severe that he couldn't place any weight on the leg, and he ended up falling against the side of elevator shaft. He was also starting to experience some shortness of breath and his chest was starting to ache.

DeSoto looked down the shaft, and called out to his partner, "Johnny, are you okay?"

"I don't know," Gage replied, finding it difficult to catch his breath. "Could you guys get me out of here before this thing drops any further?" Gage was beginning to get very short of breath, and he wanted out of there in the worst way.

Roy noticed his friend's panting, and instructed the rest of the guys, "Pull him up fast. Something's wrong."

Kelly and Lopez started to pull their friend out of the elevator shaft. Before the younger paramedic got to the seventh floor, he was experiencing severe breathlessness and the pain in his chest worsened to a nearly unbearable level. When he got there, Roy helped pull him to the floor, but Johnny collapsed, panting and clutching at his chest, saying breathlessly, "Can't breathe . . ."

"Cap, can you call another squad?" the senior paramedic asked his captain, who was standing next to him. "The patient is stable, but Johnny really needs some help here."

Captain Stanley made the request over the HT, and then asked Roy, who was getting oxygen on his partner, "What's wrong with him, Roy?"

"He may have gotten hurt when the elevator dropped, but I'm not sure." DeSoto then checked his partner's vitals, noting that his respirations were very rapid, his blood pressure was a little low, and that he was sweating heavily. He rapidly got Johnny's turnout coat off, loosened his belt, and opened his shirt. He then applied oxygen to help ease the younger paramedic's breathing.

Johnny looked at Roy anxiously and gasped breathlessly, "Hurts to breathe."

DeSoto suddenly had an idea. He pulled up Johnny's pant legs, and noted the red, swollen right calf. "Damn, he probably has a PE. We need to get him to the hospital as soon as possible."

"Roy," Johnny gasped, as he lay on the floor helplessly, "help, can't breathe."

"I know, Johnny," the senior paramedic said, trying not to sound as worried as he really was, "Just hold on a minute while I talk to the doctor." First Roy increased the flow rate of oxygen being administered to his partner, and then grabbed the biophone and relayed Johnny's vitals to the waiting physician. He also relayed his suspicions about the pulmonary embolism and DVT. He got permission to start an IV and administer some heparin and pain medication, but that was about all he could do until they got to the hospital.

By the time DeSoto finished administering the ordered medication, the younger paramedic had lost consciousness. The other squad and the ambulance had arrived on the scene and had taken over the care of the original patient. The elderly man was safely on the way to the hospital, having probably just suffered an attack of angina.

As Gage was loaded onto a gurney, Captain Stanley asked Roy, "What's going on here? He was fine a few minutes ago. That little fall couldn't have caused this." He knew the short fall Johnny took would not account for the severity of his symptoms

As Roy loaded the oxygen tank onto the gurney and placed it between his partner's legs, he said, "I think he has a blood clot in his lung, and it's making it hard for him to breathe."

They got onto the other elevator, which thankfully was working. As the elevator lowered, Cap asked, "How in the world could he get a blood clot in his lung? I thought that only happened to older people. He's what, 32 years old?"

"I know what you mean," DeSoto replied, as he pulled up Johnny's pant leg again. He pointed to his friend's leg, "See how red and swollen his leg is? I think he has another DVT, and a clot broke away from it and traveled to his lungs."

"This is serious, isn't it, Roy?" Cap asked worriedly.

"Oh yeah, it's very serious."

XXXXXXXXXX

When the ambulance arrived at the hospital, Johnny was whisked off to a treatment room, and this time, DeSoto wasn't allowed in. He went to the lounge to wait for word on how his partner was. Cap had taken him off duty so he could be at the hospital with his partner, since Johnny didn't have any other family. Roy knew this wasn't good news for his best friend. If the PE didn't kill him, being forced to leave his job would. Now that he had had a recurrent DVT and a PE to boot, he would probably have to be on Coumadin for the rest of his life, and would never be able to return to being a firefighter.

Roy couldn't have felt worse than if all this had happened to himself instead of his friend. Johnny was like the brother he never had, and he hated to see this awful thing happen to his best friend.

After what seemed like forever, but was really just a couple of hours, Dr. Brackett entered the lounge.

"How's Johnny?" Roy asked, almost afraid to learn the answer.

"Well, I won't lie to you, Roy," Dr. Brackett replied. "Right now he's critical. We did a V/Q scan, and your suspicions were correct. We found a fairly large pulmonary embolism. We had to intubate him, and I've just admitted him to the ICU."

"Is he going to make it?"

"It's going to be touch and go the next few hours. If he doesn't improve soon, we'll have to perform an embolectomy. I'm hoping that the heparin will work and we won't have to do that. It requires that we open up the chest, and it has a fairly high mortality rate."

"Doc, what caused this?" Roy asked desperately, as he paced the room and ran his hand through his hair, "I thought that first DVT was caused by the long airplane flight, but Johnny hasn't done that again. He's really active. What would cause a person his age to get a blood clot like that? He's 32 years old, for crying out loud!"

"I don't know, Roy." Brackett answered. "When Johnny improves," he deliberately said when, not if, for Roy's sake, "we'll send him to a hematologist, a blood specialist. I would say that he had some valve damage from the first clot, but this clot is in the other leg. He obviously has something wrong with him that makes him hypercoagulable."

"What could cause a person his age to be hypercoagulable?" DeSoto asked.

"It could be any number of things. Sometimes it's inherited, and sometimes some other disease could cause it," Dr. Brackett stated. He paused a moment then asked, "Do you know if anyone in his family had any problems like this?"

"His parents died in a car accident at a fairly young age, and he doesn't have any brothers or sisters. I know his father's mother died in her 50's, but I don't know of what. I don't know about any other blood relatives. The guys and I are the only real family he has."

"Well, we're not gonna get answers this way. How about we go up and see that partner of yours. Once we get him over this, we'll get some answers. I got a call from the nurse in the ICU right before I came in here. He's awake now."

"He's never gonna be able to be a firefighter again, is he?" Roy asked sadly as they left the lounge,

"I don't think so, Roy," Dr. Brackett replied, just as sadly.

XXXXXXXXXX

As always, Roy was taken aback by the sight of his best friend on a respirator with IVs and wires seemingly everywhere. He walked up to his Johnny's bedside and took hold of his partner's hand. Johnny turned his head slightly and saw it was Roy holding his hand. He couldn't speak because of the respirator, but gave his partner a feeble 'thumbs up' with his other hand.

Dr. Brackett joined Roy at the side of Johnny's bed, and said, "Johnny, I need to ask you a couple of questions. I know you can't talk, so just shake or nod your head to answer me. Do you know what happened?"

The frightened man shook his head 'no'.

"You have a pulmonary embolism, and we're giving you heparin to try to break it up. If that doesn't work pretty soon, we'll have to perform an embolectomy."

The stricken man's eyes widened in fear as he took in the information, because he knew that a pulmonary embolism was very serious. He also knew that if he had to have an embolectomy, he might not survive the procedure.

"Now, don't worry about a thing, Johnny," Dr. Brackett soothed. "You know we have the best surgeons here at Rampart and everything's gonna be just fine. We're gonna take really good care of you."

"He's right, you know," Roy added. "You'll be up and around in no time."

Gage knew that might be true, but he also knew that his career as a firefighter was more than likely over. He squeezed his best friend's hand tightly and shook his head as tears started to leak from the corners of his eyes, trying to convey his fear to his partner.

Roy and Johnny had been friends for so long, that Roy knew what his partner was thinking. He sat on the edge of the bed so he could look his friend in the eyes, "Johnny, don't worry about that right now. The most important thing is for you to get better. We'll deal with the rest later. You know I'll be with you every step of the way, whatever happens."

Johnny looked at his best friend with gratitude in his eyes. Dr. Brackett stepped closer, "Johnny, you need your rest now. I'm gonna give you something to help you sleep, and we'll be back to see you in a little while."

Gage's eyes widened in fear again. He didn't want his best friend to leave; he didn't want to be alone, even in sleep. He held onto his partner's hand even tighter, begging with his eyes that Roy not leave.

The senior paramedic looked up at Dr. Brackett, "Can I stay with him, Doc? I don't think he wants to be alone."

"Sure, you can stay. The nurse will be in with his shot, and I'll be back soon," Dr. Brackett said as he headed for the door. "Just have me paged if you need anything. I have to call that surgeon I told you about. We need to be ready in case we need to do the embolectomy."

XXXXXXXXXX

Two hours later, Johnny underwent another V/Q scan, and the embolism hadn't improved. He was taken to surgery to have it removed, so permanent damage wouldn't occur to his lungs. Along with removing the clot, and because Gage had suffered a pulmonary embolism at such a young age, the surgeon also inserted a Greenfield filter into the large vein leading to the heart to prevent any other pulmonary embolisms. This was a fairly new device that even Dr. Brackett hadn't heard of yet, and was good news for the paramedic, as he wouldn't have to worry about any more pulmonary embolisms. But he would still need to be on an anticoagulant to prevent clots in his legs.

Johnny's friends, who were keeping vigil in the waiting room, were given the good news that he had made it through the surgery, and they were all visibly relieved, though saddened about the loss of Gage's career.

The next day, after Johnny woke up and was taken off the respirator, the surgeon explained what he had done in the surgery. The dark-haired man was relieved about the filter and that he wouldn't have to worry about pulmonary embolisms anymore. He wasn't very happy about the Coumadin. He resolved to himself that he would try to find a way to continue in the career he loved, but it had to be a way that the Fire Department and the doctors would agree with.

As Gage recovered from his surgery in the hospital, Captain Stanley came to visit him. He passed on the bad news that a replacement would have to be found for him at Station 51. Johnny begged him to get a temporary replacement, since he hadn't seen the blood specialist yet, and thought that the hematologist might have an answer for him. He had an appointment to see him after his discharge from the hospital.

Stanley reluctantly agreed, thinking his younger paramedic was just prolonging the inevitable, but the captain was willing to give him a chance. He could see how determined Johnny was to return to the career that he loved so much.

After Gage's discharge from the hospital, he went to see the blood specialist, Dr. Vukovich. He was a hematologist, one of the best in his field in the state. The doctor had gone through Johnny's medical records, and had an idea of what ailed him. He checked the paramedic for every known cause of hypercoagulability at one time, because he didn't like to prolong the waiting like some doctors did to their patients. The specialist knew that checking one thing at a time was very stressful on the patients. When all the results came back, his suspicion was proven correct.

Johnny had returned to Dr. Vukovich's office for his follow-up appointment with some trepidation. He realized he might not like what he was about to find out.

The doctor explained to his new patient that he had what was called factor V Leiden. It was a genetic disorder that caused protein C and protein S resistance, which in turn caused a defect in the body's natural anticoagulation system. A person's blood just didn't get the message to quit clotting after an injury, even a very minor one, and that would lead to the DVTs. It was just recently given a name, and was considered the cause of the majority of DVTs and PEs in people under the age of 40. Dr. Vukovich had managed to acquire information on Johnny's deceased relatives, and relayed to his patient the discovery that his paternal grandmother had died from a pulmonary embolism, and undoubtedly had passed the disorder on to Johnny through his father. Since his parents had died at such a young age, they would never know if his father would have developed problems.

Gage was also warned that if he ever had children, they would have a 50% chance having the disorder.

Due to Gage's vehemence about returning to duty as a firefighter/paramedic, and the fact that he had had a Greenfield filter inserted, Dr. Vukovich readily agreed to let Johnny try aspirin instead of Coumadin, which was recently shown in studies to have some antiplatelet qualities, a mild form of blood thinning. He agreed to give Johnny three months on the aspirin, and if he did not develop any DVTs, the doctor would release him back to duty.

XXXXXXXXXX

Following his doctor's appointment, Gage immediately went over to his partner's house. Roy's wife and children were at the park, so Johnny got a chance to talk to his best friend alone. They sat in lawn chairs on the deck off the back of the house, and Johnny informed Roy of the results of his blood tests.

"I've never heard of this factor V Leiden," Roy commented.

"Well, I've never heard of it either, but it sure is making my life a living hell."

"And it's inherited?"

"Yeah, it's like a genetic defect," Johnny explained. "It's all very technical, but the main point is the blood doesn't get the message to quit clotting after an injury, even a little one. The doctor thinks it got passed on through my grandmother. I was so young when she died, that I never really knew how it happened. Dr. Vukovich found her records and told me she died of a DVT that led to a pulmonary embolism."

"Lucky for you with all the advances in medicine that you lived through yours," DeSoto pointed out.

"Tell me about it," Johnny replied. "At least with the Greenfield filter the surgeon put in, I won't have to worry about PE's any more. That's something I never want to go through again."

"You and me both. I think it took ten years off my life. When you were laying there and couldn't breathe, I don't think I've ever been that scared."

"I'm sorry you had to go through that, Roy. I was so stupid. My leg was swollen up, and I was just pretending nothing was wrong. I should have listened to Brackett. Maybe that surgery could have been avoided."

"Well, it's in the past now, and the past can't be changed. The important thing now is that you're getting the help you need," Roy said. He then asked hopefully, "Did the doctor say you could go back to work?"

"He did have some good news about that," Gage replied. "He's gonna let me try aspirin and see if that works."

"Aspirin?" Roy asked incredulously.

"Yeah, it seems aspirin causes the blood to thin a little, and he said that with my active lifestyle, it might just do the trick. I have to take one aspirin every day, and if I don't get a DVT for three months, he'll release me to go back to work."

"That's great news!" Roy exclaimed. He had really been worried that Johnny wouldn't have a chance to return to being a firefighter.

"Well, I have to get through the next three months first," the junior paramedic said. "But it's a better chance than I had before, which was pretty much 'no chance'."

"I'm really happy for you, Johnny. I'm happy for me too. It just wouldn't be the same at the station without you."

"Thanks, Roy." Johnny said with a smile.

XXXXXXXXXX

Roy and the other guys stuck with Johnny through thick and thin. They cheered him up when he was depressed, and tried to keep him occupied with various activities while he was waiting for the verdict on whether he could return to work or not.

After Gage was fully recovered from his surgery, he went to work in dispatch for a couple of months. It was a horrendous wait for him, but he luckily didn't develop any DVT's, and was able to return to work at the job he loved, and all he had to do was take one aspirin a day for the rest of his life. The paramedic didn't think it was a bad trade-off.

XXXXXXXXXX

"Morning, morning, morning," Johnny said cheerfully as he arrived in the locker room for the first time in three months. The other guys were already there getting ready for their shift.

Johnny had arrived to work with only a few minutes to spare, as usual. Some things never change. His fellow crewmembers warmly welcomed him back, and then left the room to get coffee, except Roy, of course.

"Welcome back, Johnny," Roy exclaimed. "I knew if anyone could do it you could."

"I'd like to thank you for all your help, Roy. Without you and the other guys, I would have gone stark raving mad."

"That's what friends are for," DeSoto said, as he finished buttoning his shirt.

"I know that, and I've got the best anybody could ever have," Gage said sincerely. "You and the guys are really more than my friends, you're my family."

"That's what family is for too," Roy commented with a smile.

Johnny grew serious, "Well, you guys couldn't be more of a family to me than if we were related by blood."

DeSoto replied with a twinkle in his eyes and a smile on his face, "Well, you know what they say, Johnny."

"I'm sure you can't wait to tell me."

"Blood is thicker than water," Roy said with a laugh.

The younger paramedic groaned at the ironic statement. He said, "I don't want to hear anything about thick blood ever again, partner."

The End

Author's Note: I took a lot of liberties in this story, the main one being that factor V Leiden isn't generally treated with aspirin, but I needed to give Johnny a happy ending, and aspirin is used as a mild blood thinner. Also, factor V Leiden wasn't given a name until 1993, but I had to improvise.

Johnny's experience with DVT is very loosely based on my own (except for the trip to Hawaii; my problem was a desk job, and the death defying elevator rescue), and the blood specialist is named after the doctor who diagnosed me with factor V Leiden (he was a genius!). Lucky for me, although I've had a DVT three times, I've never had a pulmonary embolism, and I don't have a Greenfield Filter, though I wish I did.

Also, I don't know for sure if firefighters can't work if they're on a blood thinner. I made that assumption because there is a high risk of excessive bleeding from minor injuries while on Coumadin, and I know I'm limited at what I can and cannot do because of being on it.

Hopefully, this story will serve to get a little awareness out there about this genetic disorder. It is involved in 20 – 40% of the cases of venous thrombosis. It affects approximately 5% of the general population, and up to 10% of the people who develop a pulmonary embolism will die from it.

GLOSSARY:

angina: (angina pectoris) chest pain caused by coronary disease

anticoagulant: preventing coagulation, or an agent that has that action

anticoagulation: prevention of clotting

antiplatelet: substance that prevents platelets from sticking together

coagulation: clotting

Coumadin (warfarin): oral blood-thinning medicine (anticoagulant)

DVT: deep venous thrombosis (blood clot in a deep vein, usually in the leg, but can be in any deep vein)

embolectomy: surgical removal of an embolus

embolism (embolus): plug of foreign material (such as blood clot) occurring in a vessel

factor V Leiden: most common genetic cause of venous thrombosis

Greenfield filter: A filter usually placed in the inferior vena cava to prevent venous emboli from reaching the lungs

H&H: hemoglobin and hematocrit

hematologist: physician who specializes in diseases and treatment of the blood and bone marrow

heparin: anticoagulant used to treat and prevent DVT and pulmonary embolism

NS: normal saline

phlebitis: inflammation of a vein

protein C/protein S: proteins that inhibit coagulation

protime: blood clotting time, short for prothrombin time, also called PT

pulmonary embolism (embolus): clot in pulmonary vein

TED hose: anti-embolism (anti-DVT) stockings

thrombus/thrombosis: blood clot in cardiovascular system

venous ultrasound: a test performed on the deep veins to determine if a DVT is present

V/Q scan: a lung function test used to diagnose pulmonary embolism


End file.
